HomeMy WebLinkAboutPermit Curb Cut 1998-10-070
DESCRIPTION OF PROJECT
PERIOD OF USE OR TIME OF CONSTRUCTTON:
tr PLANS (TWO SETS) ATTACHED
AREA: LENGTH:
TYPEOFWORK: CUT:
OTHER:
EXISTING SURFACE MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
SURFACE REPLACEIUTNT MATERIALS TO BE UTILIZED:
TYPE OF DUST CONTROL TO BE UTI
NAME OF OTHER UTILITIES IF THIS IS A JO]NT PR
WARNING OEVICES TO BE UTILIZED:
DESCRIPTION:
Advrncr rlgrnlng work rgnc protcctlon to b.
WORK SHALL COMPLY WITH CHAPTER X ARNCLE 6 OF THE CTTY
TIME:
TIME:
DEPTH:HEIGHTT
BACKFILL MATERIAL:
ln compllrncr wlth tttr on Unllorm TrrUlo
FROM DATE:
TO DATE:
D
a
DATE TSSUED:
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7477
728-37 63
INSPECTION LINE SEE INSPECTIONS ON BACK SIDE '
APPLI9ATION DATE:
PERMIT NUMBER:
fruf;rr?f,rHMENr PERMTT
LO CA TION OF WORK
STATE:)ZIP.TAX LOT:
TAX MAP:
ATE:
EXPIRATION.DATE:
PHONE:
ADDR
l--sSUbFrr
OWNER:
CONTRACTOR:
CONTRACTOR REGISTRATION NO:
PROJECT SUPERVISOR:
APPLICANT
SITE ADDRESS:
CITYr
ZlPt
ADDRESS:
PHONE:
ACCOU}{T NOt
BEOUESTED PERM rTs
T\(lPEgTIoN!AEOU|RIOT APnJcAnOfl FE!, OEPOSITQ rrucnoAcnM ENT PERMIT NO:VATD FOR SIXTY Et"tcot oAY8 ?ROM OATE Or t88U^^act 80.06Q cur srREEr o BO8E Eorxen
Q ousr coNTRoL (wpE oF coNTRoU Eo
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TYPE OF SECURITY NEPOSIT
u EuNKEr susEry EoNo Q sunttw aono El cAsH / CHECK Erfiaupg cuT pERMlr No!....lllsrtc"rorr. cuna r erenoecx ermn FORMS fl 010.00+c.l6/Fr.{c
o vAtD ?OR tlo
SECOND DRIVEWAY ISEE SEPAMTEtr
Q 010.00.+ 0.16/FT.
tr E S6.ob /
tr E e5.oo /
PROOF OF TNSURANCE: g 500,000 ililNtMUM
Qerncxeo O REOU IRED TOTAL DUE;'i I toI TOTAL DUE WITH PERMIT C
/
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REV!S|oNS U24l86 ;ORM
'ilt
CODE,TO COMPLY WTH MUTCD.
IMUTCOt.
-L-
OFFICE
,7gry47
I
REl'IEW
Commcnts:
SPECIAL
POSTINO CITY CODES ANt SMPUANCE WITH CURRENT
019
020
021
o22
o23
024
026
020
027
028
o29
030
031
032
033
T
Mlnumum 4' chrnnct rt rny polnt, rwlng.rwrY.
l"i"ii. rr"rrum 4' drpth' 3'dOoPrl'
T?inch to ba 'T' out'
Nttdt St!t. / CountV Pcrmlt'
ii" J"r. gi*nd rnclorlngr ln rldcwalk or hrndlcap rrmpr
;L;;;J.u A.c.lconcrcto vcluc boxct to grtdr'
Frorh Oll rlgnl I Gtadcd'
c"iof, wlt]h Amrrlcenr wlth olstbllltit! Act'
;;il. rllbr,72hrr. curlng tlmc' 45o0psi'
iiicrrt. rlrbr rcqulrc tolnt rcrl mrtcilrl'
DrlvrwrY nquhrr dowdr rvcrY 18''
iuuttt *ttto control plln prlor to cxcrvation'
Notlly Trrlflo Dlvldon bclorc cxcavatlgn'
Cii. iarr mrln llnc, lntlrt tm, 2% mln' e rad!'- . -
t4urt .o.ptv wlth th. Provlrlonl ol ORS 75?'641 to 757
6' Clrcuhr frolc/H2O'Vrc.
.671.
Ott No Prtchworl rllowrd'
ai; btird cur to hrvl ccntrol d'ndw llll' .- . ^;i; crttio l. porv.rrlt'd otlck mrlcd lor tlnrl lnrp'ctlon'
018 Mlnlnum 2'crulhcd rock I'mlnur'
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THE LANE
"ONE
N G COUNCIL'S
-3 32-2344
INSPECTIONS:
SEWER, STORM SEWEB, ENCROACHMENT PERMTT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
BE
N SANITARY- 72aa7o1,
SIGNATURE:
l[t1[T,i$i6";l?l?itt;l]1,,'$fifF.$:f"'Brih'J':n: *';rmtJ'J,i'l$3"B!1?3[l][ll' that proiect address rs readabre from the stre6t'
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Date
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AMOUNT RECEIVED:
RECEIVED BY:RECEIPT NO:
i
DATE PAID:
VALIDATION:
I rrretr.treNANcE:
-
E penrur tssuED BYi
FOB SIDEWALK AND CURB CW PEBMITS PLACE A COPY (COMPLETED) IN PERMIT DRAWER.
WORK tN pROGRESS DATE:
irrnnae oF coMPLETIoN:
ELEI,ENTH MO!$TH: DATE:
I
TE:
INSPECTION:
OEPOSIT BETURNED:DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
I euctrueEBtNc REVIEWED BY:
DATE:
I
INSPECTION:
IN AFTER
STATE FOR
NUMBER.
AND
ARE TO BETHE NEXTBE MADE
PLACE BUT PBIOR TO POURING CONCRETE. ri+woBK ls lNMADE
AND
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are 0n